Nepal’s Health Care Crisis: ‘Silent Emergency’ : Man and Nature Combine to Create a Nation Racked by Disease, Officials Say

Oblivious to a pouring rain, Lokmaya crouches beside a muddy rivulet and scrubs her children’s clothes with a bar of pink soap.

Her two little girls, at her side, appear to be about 4 and 8 years old. But Lokmaya doesn’t know their ages, or even her own.

“I don’t keep track of such things,” she says. But with a proud smile, she adds that she also has a son and he is 6.

Lokmaya gave birth to three other children but they did not survive infancy. She doesn’t know why and says her surviving children are often sick with fevers.

Enormous Battle

Health care is a battle of mountainous proportions in Nepal where both man and nature are the enemy, creating what health workers call “the silent emergency.”

An earthquake rumbled through the Himalayan mountains, foothills and valleys Aug. 21, killing more than 700 people in Nepal and at least 300 in neighboring India.

However, Nepal’s biggest killer is far less dramatic and strikes every day. It is diarrhea, and it claims 45,000 lives a year, according to figures compiled by the United Nations Children’s Fund (UNICEF) and the Nepalese government. Nearly all the victims are children.

Eleven percent of all babies die before their first birthday. Two out of three children under 5 years old suffer from malnutrition, further decreasing their chances of avoiding--or surviving--diarrhea and the six other most prevalent diseases: diphtheria, whooping cough, tetanus, measles, tuberculosis and polio.

Lack of Potable Water

“Nearly 50% of the diseases could be controlled easily if you could provide potable water to the people,” said Shreebatsa Prasad Shrestha, an undersecretary in the Ministry of Health.

Nepal, the fabled kingdom in the sky, is a land of beauty and mystery, luring adventurers to conquer the majestic heights of Mount Everest, to search for the Abominable Snowman, to explore the pagoda-like temples where Buddhism met Hinduism and spawned the kind of architecture that belongs in fairy tales.

It is a country where tourists are warned not to drink the water, where Western embassies have their own doctors and are poised to fly their citizens to Bangkok, Thailand, or New York or London for hospital treatment.

The Nepalese have little choice but to drink the water, and only 25% of them get it from a tap or well, Shrestha said. The rest fetch water from open streams where livestock wallow and people bathe.

Too Few Doctors

The country has one doctor for every 26,000 people, in contrast to one doctor per 5,000 people in India and one per 780 in the United States.

Lokmaya’s village of Balambhu has better health care than most in this nation of 17 million people. People can walk to the local health post in a few minutes, and the village of 1,000 is less than six miles from Katmandu, the capital, where there are free doctors.

In more remote areas, people must walk for days to reach a health post, which may have up to four staffers: a midwife and as many as three “health assistants” with first-aid kits.

Even in Balambhu, the concept of water-borne diseases such as diarrhea is rudimentary.

Multipurpose Waters

Down the road from where Lokmaya was doing her laundry, women washed their families’ breakfast dishes, their children and themselves in another tiny rivulet of water coursing through the mud.

A few yards away, a teen-age boy scrubbed a water buffalo. A smaller boy wearing only a tattered brown shirt squatted nearby, for the ground along the rivulet serves as a latrine.

Plans for development in Nepal, where the per-capita annual income is $160, anticipate that 18% of all homes will have toilets by the year 2000, compared to an estimated 3% now. Television, which started in Nepal only two years ago, has already reached 13% of the people and is expected to reach 60% by the year 2000.

Foreign health workers said they have found people quick to learn health and hygiene precautions, once they understand why they must change their habits.

Training Under Way

Joann Duffy, Katmandu director of Dooley Intermed, a New York City-based foundation, said her staff is training Nepalese nurses to conduct classes for menial workers in hospitals.

“We demonstrate how to sweep. We show them how to clean a latrine. We show them how to dig a pit for trash. We show them how to wash their hands,” said Duffy, an infection control practitioner from Torrance.

The Nepalese terrain is harder to conquer. Many areas, even those at lower altitudes, are far from roads that motor vehicles can travel.

Under a nationwide vaccination campaign aimed at combatting tuberculosis, measles and other diseases, UNICEF workers are hiking up to four days to reach remote villages.

The serum they carry in specially designed “cold packs” must be kept below certain temperatures, and the packs can only maintain that temperature for 48 hours, according to UNICEF’s chief representative in Katmandu, Lay Maung, a Burmese doctor.

To maintain the correct temperature, relays of runners follow them with blocks of ice to keep the serum cool.